膳食多酚补充对铁状态和红细胞生成的影响：系统评价和随机对照试验的荟萃分析。
Effects of dietary polyphenol supplementation on iron status and erythropoiesis: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China.
College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.
出版信息
Am J Clin Nutr. 2021 Aug 2;114(2):780-793. doi: 10.1093/ajcn/nqab068.
BACKGROUND
The iron-chelating activities of polyphenols raise concern whether there is a risk of iron deficiency or anemia induced by polyphenol supplementation. Results from clinical trials regarding the effects of polyphenol supplementation on iron status and erythropoiesis are inconclusive.
OBJECTIVE
We performed a systematic review and meta-analysis of randomized controlled trials to determine the effects of polyphenol supplementation on iron status and erythropoiesis.
METHODS
Published articles were searched between May 1988 and 7 December, 2020. Finally, we identified 34 randomized controlled trials. Random-effects meta-analyses were performed to obtain the weighted mean difference of serum iron (SI), transferrin saturation (TS), ferritin, and hemoglobin concentration. Funnel plots and Egger's test were used to determine the risk of bias. The robustness of the effect sizes was examined by sensitivity analysis.
RESULTS
Polyphenol supplementation had an inhibitory effect on the SI concentration (-13.72 μg/dL; 95% CI: -20.74, -6.71) and TS (-3.10%; 95% CI: -4.93, -1.27), with no effect on ferritin (-9.34 ng/mL; 95% CI: -28.55, 9.87). Polyphenols increased the hemoglobin concentration (8.53 g/L; 95% CI: 3.33, 13.73). In healthy participants, polyphenol reduced the TS (-3.83%; 95% CI: -7.47, -0.19) and increased the hemoglobin concentration (12.87 g/L; 95% CI: 1.61, 24.14). Similarly, polyphenol reduced the SI concentration (-8.60 μg/dL; 95% CI: -16.10, -1.10) and increased the hemoglobin concentration (8.50 g/L; 95% CI: 0.86, 16.15) in patients with metabolic diseases. In patients with β-thalassemia, polyphenol decreased the SI concentration (-23.19 μg/dL; 95% CI: -35.84, -10.55), TS (-3.23%; 95% CI: -5.54, -0.91), and ferritin concentration (-223.62 ng/mL; 95% CI: -359.32, -87.91), but had no effect on the hemoglobin concentration.
CONCLUSION
Healthy individuals and patients with metabolic diseases may benefit from the positive impact of polyphenols on erythropoiesis. Patients with β-thalassemia may benefit from the effect of polyphenols on reducing SI. This trial was registered at PROSPERO (International prospective register of systematic reviews) as CRD42020161983.
背景
多酚的铁螯合活性引起了人们的关注，即多酚补充剂是否存在导致缺铁或贫血的风险。关于多酚补充剂对铁状态和红细胞生成影响的临床试验结果尚无定论。
目的
我们进行了一项系统评价和荟萃分析，以确定多酚补充剂对铁状态和红细胞生成的影响。
方法
检索了 1988 年 5 月至 2020 年 12 月 7 日发表的文章。最终，我们确定了 34 项随机对照试验。采用随机效应荟萃分析获得血清铁（SI）、转铁蛋白饱和度（TS）、铁蛋白和血红蛋白浓度的加权均数差。使用漏斗图和 Egger 检验来确定偏倚风险。通过敏感性分析来检验效应大小的稳健性。
结果
多酚补充剂对 SI 浓度（-13.72 μg/dL；95%CI：-20.74，-6.71）和 TS（-3.10%；95%CI：-4.93，-1.27）有抑制作用，但对铁蛋白（-9.34 ng/mL；95%CI：-28.55，9.87）无影响。多酚增加了血红蛋白浓度（8.53 g/L；95%CI：3.33，13.73）。在健康参与者中，多酚降低了 TS（-3.83%；95%CI：-7.47，-0.19）并增加了血红蛋白浓度（12.87 g/L；95%CI：1.61，24.14）。同样，多酚降低了代谢性疾病患者的 SI 浓度（-8.60 μg/dL；95%CI：-16.10，-1.10）并增加了血红蛋白浓度（8.50 g/L；95%CI：0.86，16.15）。在β-地中海贫血患者中，多酚降低了 SI 浓度（-23.19 μg/dL；95%CI：-35.84，-10.55）、TS（-3.23%；95%CI：-5.54，-0.91）和铁蛋白浓度（-223.62 ng/mL；95%CI：-359.32，-87.91），但对血红蛋白浓度无影响。
结论
健康个体和代谢性疾病患者可能受益于多酚对红细胞生成的积极影响。β-地中海贫血患者可能受益于多酚降低 SI 的作用。该试验已在 PROSPERO（国际前瞻性系统评价注册库）注册，注册号为 CRD42020161983。
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